=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295809978
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RADIATION ONCOLOGY ASSOCIATES OF GULF COAST, L.L.P.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 02/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 HIGHWAY 59 LOOP N
-----------------------------------------------------
City | WHARTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77488-7807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-576-9812
-----------------------------------------------------
Fax | 361-574-1580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1502 E RED RIVER ST #330
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77901-5523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-576-9812
-----------------------------------------------------
Fax | 361-574-1580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | MRS. GRACE LING CHEN
-----------------------------------------------------
Credential | R.N.,PH.D.
-----------------------------------------------------
Telephone | 361-576-9812
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0203X
-----------------------------------------------------
Taxonomy Name | Therapeutic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------